Which of the following nursing actions should be included in the plan of care for a client who is being treated for bleeding esophageal varices with balloon tamponade?

Question

Quizplus · Accepted Answer

A common complication of balloon tamponade is occlusion of the airway by the balloon so it is important to monitor the client's respiratory status. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway.
Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8-12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

Which of the Following Nursing Actions Should Be Included in the Plan